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For chronic pain, use for
2 weeks at initial dosage
and reevaluate efficacy;
titrate up as needed and
if safe; if not effective after
a 4-week trial, consider
changing NSAID, or adding
or changing to another
intervention

Chronic opioid therapy should
incorporate an opioid use agreement
that includes functional goals
for outcome, not reduction of pain
intensity alone

Topical anesthetics

Capsaicin

0.025% or 0.075% cream;
apply to skin over affected
joint(s) or limb TID-QID

High-dose capsaicin topical
dermal patch; apply for
30-90 minutes

Lidocaine dermal patch 5%

Apply 1-3 patches over
affected area for 12 hours
QD; must be removed for
12 hours

Capsaicin

For noninflammatory and inflammatory
OA, HIV-SN

For OA or neuropathy, apply to
skin over affected joint or area

May take several days to achieve
pain relief; initial application usually
accompanied by sensation of heat
or burning

For neuropathy, a single capsaicin
patch application can provide pain
relief for up to 12 weeks

Lidocaine

Topical lidocaine may be used for
neuropathic pain, but for HIV-SN
it has not shown significant benefit
over placebo, and is expensive;
consider brief trial in patients with
incomplete pain relief on other
therapies

Colchicine

0.6 mg BID

For inflammatory OA with refractory
symptoms

Avoid use for patients with renal
or hepatic disease

Use in conjunction with NSAIDs

Consider for patients with refractory
inflammatory OA, as many
have calcium pyrophosphate crystals
in the synovial fluid